Refractory Immune Thrombocytopenic Purpura with Abdominal Splenosis: A Complex Case

Table 1

Laboratory workup of thrombocytopenia.

Test	Result	Reference range
Complete blood count
White blood cells × 10^9/L	6.14	4–11,000
Hemoglobin (g/dL)	14.5	12.0–16.0
Hematocrit (%)	43.0	35.0–47.0
Platelets × 10^3/L	1	150–450
Complete metabolic panel
Sodium (mmol/L)	141	136–145
Potassium	3.4	3.4–4.8
Chloride	105	98–107
Bicarbonate	23	23–31
Blood urea nitrogen (mg/dL)	13	10–20
Creatinine	1.0	0.6–1.1
Calcium	8.8	8.5–10.5
Alkaline phosphatase (U/L)	53	40–150
AST (U/L)	30	<35 U/L
ALT (U/L)	46	<55 U/L
Total bilirubin (mg/dL)	0.7	0.3–1.2
Miscellaneous
Hepatitis B surface antigen	Negative	Negative
Hepatitis B core total antibody	Negative	Negative
Hepatitis C antibody	Negative	Negative
Hepatitis C viral load	Negative	Negative
HIV 1/2 antibodies and antigen	Negative	Negative
Vitamin B-12 (pg/mL)	434	210–815
Folate (ng/mL)	9.8	7.0–31.0
Lactate dehydrogenase (U/L)	221	125–250
Haptoglobin (mg/dL)	137	30–200
Reticulocyte count (%)	1.71	0.70–2.50
Reticulocyte count absolute	0.07	—
Immature reticulocyte fraction	10.6	1–100
Fibrinogen (mg/dL)	365	150–400
D-dimer (ng/mL)	<150	<243
Protime (sec)	11.9	9.0–13.0
Partial thromboplastin time (sec)	32.8	25.0–38.5
Thyroid-stimulating hormone	4.45	0.45–4.50
Antinuclear antibody	Negative	Negative
Helicobacter pylori	Negative	Negative
Parvovirus B19 Ab, IgG	Positive	Negative
Parvovirus B19 Ab, IgM	Negative	Negative
Epstein–Barr virus (EBV) capsid IgM	<0.2	<0.9
EBV capsid IgG	>8.0	<0.9
EBV heterophile IgM	<0.2	<0.9
EBV viral load	Negative	Negative
IgA (mg/dL)	249.0	63.0–484.0
IgG (mg/dL)	838.0	540.0–1,822.0
IgM (mg/dL)	357.0	22.0–240.0